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a Department of
Rheumatology, Copenhagen County Hospital Gentofte, DK-2900 Hellerup,
Denmark, b Finsen Laboratory, Copenhagen University
Hospital, Copenhagen, Denmark
Correspondence to: Dr O Slot.
Accepted for publication 12 April 1999
OBJECTIVE
Urokinase
type plasminogen activator (uPA) catalyses the formation of the
proteolytic enzyme plasmin, which is involved in matrix degradation in
the processes of tissue remodelling. Because of a surface bound uPA
receptor (uPAR), expressed by some cell types (for example,
macrophages, malignant cells and inflammatory activated synoviocytes),
the action of uPA can be localised and intensified. uPAR seems to have
a role in the mechanisms leading to invasive growth of malignant tissue
and the rheumatoid pannus. uPAR may become cleaved at its cell surface
anchor, thus forming a free soluble receptor (suPAR). suPAR is
detectable in low but constant values in plasma of healthy people,
while increased concentrations are found in patients with disseminated
malignant disease, so that suPAR may be an indicator of invasive growth
and tissue remodelling. suPAR concentrations in plasma have not
previously been measured in rheumatic patients. A controlled cross
sectional measurement was performed of suPAR in plasma of patients with
various inflammatory rheumatic disorders with special reference to
rheumatoid arthritis (RA).
METHODSsuPAR in
plasma was measured by ELISA technique in patients with RA (n=51),
reactive arthritis (ReA) (n=23), primary Sjögren's syndrome (PSS)
(n=42) and sex and age matched healthy controls (n=53).
RESULTSIn the control
group suPAR (median) was 0.91 (range 0.56-1.94) µg/l. Median suPAR
value in RA was 1.47 (range 0.65-6.62) µg/l; in ReA 0.68 µg/l
(range 0.52-1.48) and in PSS 1.12 µg/l (range 0.76-1.92); p versus
controls <0.001 in all patient groups. suPAR values in RA were also
significantly increased compared with ReA (p<0.001) and PSS (p=0.004)
groups. suPAR in RA was positively correlated to C reactive protein
(CRP) (p<0.01) and erythrocyte sedimentation rate (p<0.05) and number
of swollen joints (p<0.05). The ReA group had the highest CRP values
of all groups, but at the same time the lowest suPAR concentrations in plasma.
CONCLUSIONSIncreased
suPAR concentrations were found in plasma in RA, and to a smaller
extent also in PSS, but not in ReA. In RA suPAR is related to disease
activity. suPAR seems though not merely to be an acute phase reactant
like CRP. Increased suPAR values might reflect erosive activity in RA.
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